Insanity: A Beginner’s Guide

I’ve been reading about the history of mental health and it’s fascinating. Here’s a very, very potted, vastly oversimplified version, with my apologies to anyone who really knows anything about it:

Thousands of years ago our ancestors reckoned that demons and evil spirits could get in through our heads. The earliest sort of brain surgery was called ‘trepanning’ and involved cutting a circular hole in the head to let the evil spirits out. What’s most surprising about this is that bone growth round the hole shows that some people survived the op.  Similarly, the Romans used electric eels to administer shock treatment – an early precursor of ECT, which is still used, but under strict guidelines.  Nowadays ECT patients are given sedatives and muscle relaxants before electrodes are attached to the skull and an electric current passes into it via a control box. It can be effective in treating serious disorders such as depression, but scientists still aren’t sure quite how it works.

Other primitive theories about the causes of mental illness included breaking a taboo, loss of the soul or sorcery and witchcraft. In the medieval period, it was believed that sick people were possessed by evil spirits sent by witches – earthly servants of the devil.  This led to witch hunts where thousands of people were burned to death, many as part of the Spanish inquisition. Even today there are documented cases of mentally ill children being left to starve to death in some European and Asian countries – not to mention recent and well-documented cases of neglect and abuse such as Victoria Climbie.

The Greeks thought that mental health problems were punishment from the gods for man’s arrogance.  Hippocrates, (the Greek philosopher viewed as the father of modern medicine) argued that there were four humours, or vital fluids in the body.  When these were unbalanced they led to sickness.  What’s interesting is that some psychiatrists today think that many mental illnesses are caused by chemical imbalances in the brain. Anti-depressants for example, are synthesised versions of the brain’s ‘mood enhancing’ chemicals.

Plato advocated that the ‘mad’ should be locked up at home – a practice used largely on women, before the development of asylums, in the early 19^thc. Asylums were established in the Victorian era for the physically and mentally sick (you can see what they looked like at www.ukasylums.org.uk/index.asp).  Ironically, the word means ‘place of refuge’ – but in reality these were often dumping grounds for those on the margins of society or whose behaviour was deemed ‘unacceptable’. Treatment including vomiting and purging to keep inmates, weak, starvation, blood-letting and even cutting out the woman’s clitoris, as the sex organs were thought to ‘cause’ depression.   Around this period we also see the criminalising of mental illness, as people could be prosecuted or imprisoned for anti-social behaviour – the same debates around madness versus badness, still rage today.

By the early 18thc madness was starting to be viewed as a disease of the mind, as links were made between the nervous system, senses and intellect.  In 1848, Phineas Gage, a railroad worker was involved in an accident where a steel rod became lodged in his brain.  As a result he suffered epileptic fits, aggression and  a personality change.  Doctors concluded that the frontal lobe area of the brain was what affected personality and mood – paving the way for the brutal and irreversible lobotomy.  (Interestingly, the instigator of such treatment was later paralysed after being shot by a patient he had lobotomised).

With the rise of talking cures and behavioural therapy, the early Victorian era saw a move away from medicine-based treatments.  After the 1950s lithium was shown to be an effective treatment for mania and manic-depressive psychosis, whilst in the 60s generations of women were prescribed the wonder drug valium for their nerves – before it was recognised to be highly addictive and withdrawn from widespread use. This paved the way for the anti-psychiatric movement of the 60s and 70s, pioneered by psychiatrists such as Laing, who argued that madness was a social issue. During the 19^th and early 20^th centuries, most mental health professionals specified the genetic causes of mental illness. Then, during the mid-20thc, emphasis was placed on social rather than biological causes. Now the causes of mental illness are thought of as being a combination of social and biological factors.

The population inside British psychiatric hospitals reached a peak in the mid- 1950s, but since the 1990s increasing numbers of hospital have been closed.  After the 1990s NHS and Community Act, the goal has been to care for more patients within the community.  This includes using mental health staff from a range of different disciplines, the growth of primary care (GP) referrals and use of medications to enable sufferers to maintain greater independence. The success of this approach is currently being debated.